?Involvement? in cognitive-behavioral therapy with children: Process and its relationship to outcome

Abstract

The rates of specific therapist and client verbal behaviors were examined within the context of behavioral, cognitive-behavioral, and attention-control interventions with children exhibiting classroom behavior problems. The 27 third- through sixth-grade children were referred by their teachers for participation in a treatment outcome study (Kendall & Braswell, 1982). All subjects were exposed to identical training materials and were seen for 12 50-minute sessions conducted over 7 weeks. All sessions were audiotaped. Seven-minute samples from the beginning, middle, and end of sessions 1, 2, 3, 10, 11, and 12 were scored according to a 13-category coding system. Correlations between these process categories and independent measures of treatment outcome suggested that child and therapist behaviors indicating active, positive “involvement” with the therapy tasks were associated with improvement and maintenance of therapy gains as assessed by teacher ratings of classroom behavior, while there were few significant relationships between the processes categories and the task performance and self-report measures of outcome and maintenance. In addition, in-session behavior was, for the most part, consistent with therapy labels. The importance of involvement in treatment, as a key factor in the quality of treatment, is discussed.